Emergency Contact Information

Background Information

Have you ever been convicted of a crime (felony or misdemeanor) other than a traffic violation?

Yes

No

Has a civil or criminal complaint ever been filed against you that alleged misconduct or child abuse by you or your participation in or facilitation of such activities?

Yes

No

Have you ever chosen not to renew or continue any employment or volunteer service, had your employment or volunteer service terminated, or been subject to any internal disciplinary action relating to allegations of any misconduct or child abuse by you?

Yes

No

If YES to above | Upload File:

If YES to any above, please attach a separate sheet of paper explaining the nature, date, and place of conviction

Please Read Carefully

• The information contained in this application is true and correct to the best of my knowledge.
• I understand that CLASP will conduct background checks on me, including criminal activity checks, and I consent to whatever background checks CLASP considers necessary.
• I understand and authorize any references, or any other person or organization, whether or not identified in this application, to give any information (including opinions) regarding my character and fitness for service.
• I hereby release any reference contact, whether identified or not in this application, and waive any and all claims, liability for damages of whatever kind or nature which may at any time result to me, my heirs/family, on account of compliance with this authorization, excepting only the communication of knowingly false information.
• I am aware that background checks may be performed periodically.

Signature*

By typing my name here, I verify the information contained in this application is true and correct to the best of my knowledge, and that this serves as my signature: *